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Organization
EAST SIDE FAMILY PRACTICE SC
Active
Organization
EAST SIDE FAMILY PRACTICE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH ROBERT DOBSON D.O. (PRESIDENT)
(920) 437-4366
Entity
Organization
Contact information
Practice address
424 S MONROE AVE STE 106, GREEN BAY, WI 54301-4054
(920) 437-4366
(920) 437-0954
Mailing address
424 S MONROE AVE STE 106, GREEN BAY, WI 54301-4054
(920) 437-4366
(920) 437-0954
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26550
WI
208D00000X
General Practice Physician
26550
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30021900
—
WI
01
—
80085001
RR MEDICARE PROV #
—
Enumeration date
02/22/2007
Last updated
10/25/2010
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